Introduction: Adverse pregnancy outcomes (APOs) are early indicators of long-term cerebrovascular risk. Studies suggest links between APOs and early cerebral small vessel disease (CSVD), but few prospective studies have investigated the association. The ongoing nuMoM2b Heart Health Study (nuMoM2b HHS) has followed >5000 women since 2010–2014, early in their first pregnancies. Objective: To investigate associations between APOs and MRI markers of CSVD: enlarged perivascular spaces (PVS) and silent brain infarcts (SBI), in nuMoM2b HHS participants. Methods: 3T brain MRI scans were acquired from stroke-free nuMoM2b HHS participants at two clinical sites between December 2022 - June 2024. Clinical data, pregnancy history were obtained through surveys with confirmation by medical chart abstraction. The primary exposure was one or more of the following APOs in any pregnancy: hypertensive disorders of pregnancy, preterm birth, fetal growth restriction, stillbirth, or small for gestational age infant. MRI markers of CSVD were manually reviewed. Enlarged PVS were defined as <5 mm, T1-hypointense lesions without FLAIR hyperintensity or rim. We applied a semiquantitative score (0–2) to 14 brain regions, giving a total possible score from 0 to 28. SBI was defined as any lacunar or embolic appearing infarct, either acute, subacute, or chronic in imaging, without clinical symptoms. SBI was considered a binary outcome. Results: A total of 133 women (mean age 41 years, 58% Hispanic) were included in this analysis, of whom 42 (32%) had any APO. Demographic and clinical characteristics are shown in the Table . Participants with APO history had a higher proportion of current hypertension (45% vs 19%, p=0.001) and obesity (69% vs 41%, p=0.003). There was no difference in the global or regional burden of PVS between participants with and without APO history. Overall, 9% of participants had SBI, including 12% of participants with APOs and 8% of those without APOs. Adjusting for race/ethnicity, odds of SBI did not differ in those with and without APO (adjusted OR 2.1, 95% CI 0.6-7.3). Conclusion: In a multi-ethnic cohort of 133 midlife women followed since early in their first pregnancies, vascular risk factors, including chronic hypertension and obesity, were common, and 9% had at least one SBI. MRI markers of CSVD did not differ significantly by history of APO. Larger prospective studies are needed to understand whether and how pregnancy history influences the risk of CSVD in midlife.
Sariyeva et al. (Thu,) studied this question.